Case Report

Musical Hallucinations in Patients with Lyme Disease

Authors: Raphael B. Stricker, MD, Edward E. Winger, MD


Musical hallucinations are poorly understood auditory hallucinations that occur in patients with otologic or neurologic diseases. We report the first cases of musical hallucinations in two patients with neurologic Lyme disease. Both subjects were women with clinical and laboratory evidence of chronic Lyme disease, progressive neurologic dysfunction, and abnormal magnetic resonance imaging of the brain. There was no evidence of hearing loss in either case. Musical hallucinations had a sudden onset and took the form of patriotic or operatic music. The auditory hallucinations disappeared with intravenous (IV) antibiotic therapy in both patients, but the hallucinations recurred when IV antibiotic therapy was discontinued in one case. Response to therapy was accompanied by an increase in the CD57 lymphocyte subset in one patient, whereas recurrent hallucinations were associated with persistently low CD57 levels in the other case. We conclude that musical hallucinations may be associated with neurologic Lyme disease. These auditory hallucinations appear to respond to IV antibiotic therapy. Patients with musical hallucinations of unknown cause should be tested for infection with the Lyme disease spirochete.

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1. Berrios GE. Musical hallucinations: A historical and clinical study. Br J Psychiatry 1990; 156: 188–194.
2. Gordon AG. Musical hallucinations. Neurology 1994; 44: 986–987.
3. Gordon AG. Musical hallucinosis with brainstem lesions. Can J Neurol Sci 1997; 24: 360–361.
4. Peschel E, Peschel R. Donizetti and the music of mental derangement: Anna Bolena, Lucia di Lammermoor, and the composer's neurobiological illness. Yale J Biol Med 1992; 65: 189–200.
5. Kasai K, Asada T, Yumoto M. Evidence for functional abnormality in the right auditory cortex during musical hallucinations. Lancet 1999; 354: 1703–1704.
6. Schielke E, Reuter U, Hoffmann O, Weber JR. Musical hallucinations with dorsal pontine lesions. Neurology 2000; 55: 454–455.
7. Clark J. Case history of a patient with musical hallucinations and Parkinson's disease. Int J Geriatr Psychiatry 1998; 13: 886–887.
8. Stephane M, Hsu LK, Hoffman R. About the mechanisms of musical hallucinations. Med Hypotheses 1999; 53: 89–90(letter).
9. Stein SL, Solvason HB, Biggart E. A 25-year-old woman with hallucinations, hypersexuality, nightmares, and a rash. Am J Psychiatry 1996; 153: 545–551.
10. van den Bergen HA, Smith JP, van der Zwan A. Lyme psychosis [in Dutch]. Ned Tijdschr Geneeskd 1993; 137: 2098–2100.
11. Pachner AR. Neurologic manifestations of Lyme disease, the new “great imitator”. Rev Infect Dis 1989; 11( Suppl 6): S1482–S1486, 1989.
12. Straubinger RK. PCR-based quantification of Borrelia burgdorferi organisms in canine tissues over a 500-day postinfection period. J Clin Microbiol 2000; 38: 2191–2199.
13. Cadavid D, O'Neill T, Schaefer H. Localization of Borrelia burgdorferi in the nervous system and other organs in a nonhuman primate model of Lyme disease. Lab Invest 2000; 80: 1043–1054.
14. Frey M, Jaulhac B, Piemont Y, Marcellin L, Boohs PM, Vautravers P, et al. Detection of Borrelia burgdorferi DNA in muscle of patients with chronic myalgia related to Lyme disease. Am J Med 1998; 104: 591–594.
15. Montgomery RR, Nathanson MH, Malawista SE. The fate of Borrelia burgdorferi, the agent for Lyme disease, in mouse macrophages: Destruction, survival, recovery. J Immunol 1993; 150: 909–915.
16. Linder S, Heimerl C, Pingerle V. Coiling phagocytosis of Borrelia burgdorferi by primary human macrophages is controlled by CDC 42 Hs and Rac 1 and involves recruitment of Wiskott-Aldrich syndrome protein and Arp2/3 complex. Infect Immun 2001; 69: 1739–1746.
17. Stricker RB, Winger EE. Holmes-Adie syndrome and Lyme disease. Lancet 2001; 357: 805.
18. Stricker RB, Winger EE. Decreased CD57 lymphocyte subset in patients with chronic Lyme disease. Immunol Lett 2001; 76: 43–48.
19. Burrascano JJ Jr. Lyme disease, in Rakel RE (ed): Conn's Current Therapy 1997. Philadelphia, W.B. Saunders Co., 1997, pp 140–143.
20. Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis 1997; 25( Suppl 1): S52–S56.
21. Stricker RB, Burrascano J, Winger E. Long-term decrease in the CD57 lymphocyte subset in a patient with chronic Lyme disease. Ann Agric Environ Med 2002; 9: 111–113.
22. Jungalwala FB. Expression and biological functions of sulfoglucuronyl glycolipids (SOOLs) in the nervous system: A review. Neurochem Res 1994; 19: 945–957.
23. Nair SM, Zhao Z, Chou DK. Expression of HNK-1 carbohydrate and its binding protein, SBP-1, in apposing cell surfaces in cerebral cortex and cerebellum. Neuroscience 1998; 85: 759–771.
24. Zhao Z, Nair SM, Chou DK. Expression and role of sulfoglucuronyl (HNK-1) carbohydrate and its binding protein SBP-1 in developing rat cerebral cortex. J Neurosci Res 2000; 62: 186–205.
25. Cebo C, Dambrouck T, Maes E, Laden C, Strecker G, Michalski JC, et al. Recombinant human interleukins IL-1α, IL-1β, IL-4, IL-6, and IL-7 show different and specific calcium-independent carbohydrate-binding properties. J Biol Chem 2001; 276: 5685–5691.

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